Chronic gastritis

In the development of chronic gastritis, the influence of various exogenous and endogenous factors plays a role. In childhood, violation of the regime and diet is of particular importance: improper feeding rhythm with long breaks between meals; dry eating, fast and insufficient chewing of food; the use of excessively spicy, rough food; systematic overeating.
They also attach great importance to neuro-reflex and toxic effects associated with various diseases of the food canal, the presence in the child’s body of foci of chronic infection, neurosis, endocrine disorders.
M.S. Maslov, D.A. Bertova point to the role of acute gastritis as one of the reasons for the subsequent development of a chronic inflammatory process of the gastric mucosa. Attention is also drawn to experimental and clinical observations, indicating the likelihood in some cases of an allergic origin of chronic gastritis.
A certain role in the occurrence of chronic gastritis can be played by a congenital predisposition, which indicates the need for a thorough clarification of the family history.
Based on a histological examination of sections of the gastric mucosa obtained by aspiration biopsy, C. G. Masevich distinguishes superficial gastritis, gastritis with lesions of the glands without atrophy, as well as atrophic gastritis.
Pathogenesis. The variety of essentially etiological factors of chronic gastritis determines the complexity of its pathogenesis, unequal in various forms of the disease. At the same time, they attach great importance to the breakthrough of the so-called protective mucous barrier formed by a viscous secretion and a layer of mucus-forming epithelium located above the main and parietal cells of the gastric mucosa. Violation of the protective barrier and normal continuous regeneration of the cells of the mucous membrane can result from the ingestion of caustic and toxic substances, roughage into the stomach. Finally, functional, and then structurally-organic changes can be caused by prolonged neuro-reflex, humoral disorders, and eating disorders.
Currently, there is no single universally recognized classification of chronic gastritis that develops in childhood. Below is one of the working classifications, built taking into account the etiology and clinical and functional characteristics of the disease. Working classification of chronic gastritis 1. According to the etiological criterion, alimentary, neurogenic, infectious-toxic, irritative, metabolic-endocrine, allergic, unclear etiology. 2. On a functional basis. a) gastritis with preserved (or increased) secretory function; b) gastritis with secretory insufficiency. 3. According to the clinical course: a) mild, moderate or severe; b) often or rarely exacerbated; c) phase of exacerbation, decaying exacerbation, remission. An approximate sample of diagnosis according to this classification: chronic nutritional gastritis with secretory insufficiency; light form; rarely exacerbating, in the phase of decaying exacerbation.

Clinic of chronic gastritis

Chronic gastritis is characterized by a distinct cyclical course. Its exacerbations can occur at any time of the year, but more often in spring and autumn. Until puberty, girls are more likely to get sick. The onset of the disease in more than half of the children coincides with the time of entry to school, which can be attributed to a sharp change in the general and nutritional regime, increased emotional and physical stress.
A distinctive feature of the clinic of chronic gastritis is, as a rule, a rich subjective symptomatology of the disease, characterized by an abundance of bright, distinct sensations and symptoms with a comparative scarcity of data from an objective study. Therefore, a thorough and directed history is of particular importance for the correct and timely diagnosis of the disease. It should be borne in mind that some patients, especially those of preschool age, unable to understand their feelings, find it difficult to describe them and prefer to remain silent about them.
Observations indicate certain differences in the clinical manifestations of chronic gastritis in children, occurring with reduced or increased secretion of gastric juice.
A constant symptom of the disease is abdominal pain, often localized in the epigastric and right hypochondrium. With reduced secretion of gastric juice, it is dull, spilled, usually appears soon after eating and does not depend on the nature of the food. Chronic gastritis with preserved and increased secretion is characterized by acute paroxysmal pain, most often occurring 1 to 2 hours after eating and often provoked by the consumption of spicy, rough food.
The most pronounced pain syndrome is expressed in a combination of inflammatory lesions of the gastric mucosa and duodenum – gastroduodenitis. In these cases, pain often appears 2 to 3 hours after eating and subsides soon after it, often night pain occurs. Gastroduodenitis in children is almost always accompanied by a constant increase in gastric secretion, its level on an empty stomach. The state of the secretory function of the stomach in chronic gastritis significantly affects the features of dyspeptic syndrome. So, with gastritis with secretory insufficiency, there is a decrease in appetite, an aversion to cereals and dairy dishes, often nausea and vomiting, which occurs 2 to 3 hours after eating. With hypersecretion and increased acidity, most children have good appetite, nausea and vomiting are much less common, at the same time, belching is acidic, heartburn comes to the fore, half of patients have a tendency to constipation. Children with chronic gastritis usually do not lag behind their peers in physical development. Many of them are irritable, emotionally unstable. An objective study often reveals a significant overlay of the tongue, sensitivity is constantly determined during striking or deep palpation in the epigastric region. Radiologically in chronic gastritis, a change in the relief of the gastric mucosa, as well as motor and secretory disorders, are often noted. However, this does not play a significant role in the diagnosis of the disease due to the significant variability of the x-ray picture of the relief of the mucous membrane and motility of the stomach of healthy children in the conditions of administration of a contrast medium.

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